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FLUOTHANE麻醉의 臨床的硏究 : 特히 肝機能에 미치는 影響에 關하여
陳相浩 慶北大學校 1964 論文集 Vol.8 No.-
Fluothane is a potent anesthetic agent that has gained wide acclaim for its rapid induction and recovery without significant side effects during or after anesthesia. Although it had been reported that fluothane does not alter the function or the histology of the liver either in humans or experimental animals, some recent reports of definite liver damage with some fatalities following fluothane anesthesia brings this this question into prominence. The mechanism of liver damage in the reported cases is obscure, and although speculation centers on the anesthetic as the causative agent, the problem is complicated by a multiplicity of possible etiological factors, e.g., viral hepatitis, hypoxia, direct injury to the liver during intraabnomival surgery, etc. In view of these facts, the author has performed a clinical and laboratory study on 165 cases on various types of surgery under fluothane anethesia, and in 23 cases liver function studies were performed and the results compared with 19 similar surgical cases in which ether was the anesthetic agent. The retults of the clinical study are as follow: 1. A marked diminution in secretions from the tracheo-bronchial tree during the course of surgical anesthesia. 2. Mild respiratory depression which was easily controlled. 3. Mild depression of cardiac rate. In 5 cases(3%) during induction and in 1 case(0.6%) during mainteanance, the rate dropped more thand 20 per minute, but this was readily corrected by administration a atropine. 4. Mild depression of blood pressure. A fall of more than 20㎜Hg. in systolic pressure occured in 11 cases(6.8%) during induction and in 12 cases(7.5%) during maintenance. These chagnes were well controlled by vasopressor drougs. 5. Continuous ECG monitoring in 4 children undergoing thoracotomy revealed sinus rhythm in all cases but with transient changes of multifocal ventricular premature contractions, bigeminy, and flattening of T-waves in two cases. These changes were abolished by ventilation with high concentration of oxygen. 6. During a follow-up period of approximately two months in most cases, no clinical evidence of impairment of liver function was detected. The results of the effect of fluothane on liver function as compared with ether are as follow: 1. Bromsulphalein retention:-In fluothane anesthesia group. the mean B.S.P. retention curve went up to 5.85% in 1-3 days following anesthesia and returned to preanesthesia level in about a week. In ether anesthesia group. the mean B.S.P. retentiion curve followed almost the same pattern as in fluothane group but the curve was flat showing no significant change. 2. The serum bilitubin level also showed tendency to rise after anesthesia. the peak appearing in 1-3 days and down to preanesthetic level in a week or so in fluothane group. while in ether group the peak appeared in 6-7 days and down to preanesthetic level in about 10 days following anethesia. 3. The rest of liver function tests showed no significant changes before or following anestheisa, both in fluothane and ether group except for serum protein which showed some drop until one week after anesthesia in fluothane group. In this study no cases with definite clinical evidence of liver damage were found following administration of fluothane anesthesia during a follow-up of period of about two months, but in some cases laboratory evidence of derangement of liver function was noted by a significant alteration of liver function tests. Even though these findings were trasient, they were more marked than in a control group anesthetized with ether, which is at least suggestive that fluothane, if not the direct etiological agent, may potentiate any or all of various other factors that may be present which are potentially deleterious to hepatic function. While the possibility of this role in the mechanism of production of liver damage remains, it behooves those of us responsible for patient care during anesthesia to use the utmost caution in case selection for fluothane administration in an attempt to eliminate or minimize the possibility of liver damage as a result of the anesthesia.